Acute and Critical Care

Original Articles

Pediatrics
Effects of rescue airway pressure release ventilation on mortality in severe pediatric acute respiratory distress syndrome: a retrospective comparative analysis from India: Sudha Chandelia, Sunil Kishore, Maansi Gangwal, Devika Shanmugasundaram; Acute Crit Care. 2025;40(1):113-121. Published online February 28, 2025; DOI: https://doi.org/10.4266/acc.002520

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Abstract PDF: Background
Pediatric acute respiratory distress syndrome (PARDS) has a mortality rate of up to 75%, which can be up to 90% in high-risk patients. Even with the use of advanced ventilation strategies, mortality remains unacceptably high at 40%. Airway pressure release ventilation (APRV) mode is a new strategy in PARDS. Our aim was to evaluate whether use of APRV mode in severe PARDS was associated with reduced hospital mortality compared to other modes of ventilation.
Methods
This was a retrospective comparative study using data from case files in a pediatric intensive care unit of a university-affiliated tertiary-care hospital. The study period (January 2014 to December 2019) covered three years before routine use of APRV mode to three years after its implementation. We compared severe PARDS patients in two groups: The APRV group (who received APRV as rescue therapy after failing protective ventilation); and The Non-APRV group, who received other modes of ventilation.
Results
A total of 24 patients in each group were analyzed. Overall in-hospital mortality in the APRV group was 79% versus 91% in the Non-APRV group. In-hospital mortality was significantly lower in the APRV group (univariate analysis: hazard ratio [HR], 0.27; 95% CI, 0.14–0.52; P=0.001 and multivariate analysis: HR, 0.03; 95% CI, 0.005–0.17; P=0.001). Survival times were significantly longer in the APRV group (median time to death: 7.5 days in APRV vs. 4.3 days in non-APRV; P=0.001).
Conclusions
Use of rescue APRV mode in severe PARDS may yield lower mortality rates and longer survival times.

Nursing
Nurses’ knowledge, attitude, and perceived barriers toward protective lung strategies of pediatrics mechanically ventilated patients in a tertiary care hospital in Pakistan: Tasnim Zainib, Salma Rattani, Nimira Asif, Hussain Maqbool Ahmed Maqbool; Acute Crit Care. 2025;40(1):128-135. Published online February 19, 2025; DOI: https://doi.org/10.4266/acc.004761

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Abstract PDF Supplementary Material: Background
Protective lung strategies (PLS) are guidelines about recent clinical advances that deliver an air volume compatible with the patient’s lung capacity and are used to treat acute respiratory distress syndrome. These mechanical ventilation guidelines are not implemented within intensive care units (ICUs) despite strong evidence-based recommendations and a dedicated professional staff. Nurses’ familiarity with clinical guidelines can bridge the gap between actual and recommended practice. However, several barriers undermine this process. The objectives of this study were to identify those barriers and explore the knowledge, attitudes, and behavior of ICU nurses regarding the implementation of PLS.
Methods
This was a descriptive, cross-sectional study. The participants were nurses working in the six ICUs of a pediatric tertiary care hospital in Lahore, Pakistan. Using purposive sampling with random selection, the total sample size was 137 nurses. A summative rating scale was used to identify barriers to the implementation of PLS.
Results
Overall, the nurses’ barrier score was high, with a mean of 66.77±5.36. Across all the barriers subscales, attitude was a much more significant barrier (35.74±3.57) to PLS than behavior (6.53±1.96), perceived knowledge (17.42±2.54), and organizational barriers (7.08±1.39). Knowledge-related barriers were also significantly high.
Conclusion
This study identified important barriers to PLS implementation by nurses, including attitudes and knowledge deficits. Understanding those barriers and planning interventions to address them could help to increase adherence to low tidal volume ventilation and improve patient outcomes. Nurses’ involvement in mechanical ventilation management could help to safely deliver air volumes compatible with recommendations.

Pediatrics
Hyper- and hypomagnesemia as an initial predictor of outcomes in septic pediatric patients in Egypt: Aya Osama Mohamed; Acute Crit Care. 2025;40(1):105-112. Published online February 4, 2025; DOI: https://doi.org/10.4266/acc.000480

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Abstract PDF: Background
Critically ill septic children are susceptible to electrolyte abnormalities, including magnesium disturbance, which can easily be neglected. This study examined the potential correlation between serum magnesium levels upon admission to the pediatric intensive care unit (PICU) and the outcomes of critically ill septic patients.
Methods
This prospective study, conducted from May 2023 to November 2023, included 76 children with sepsis who underwent clinical and lab assessments that included initial magnesium levels. The outcome of sepsis was documented. Predictors of mortality were identified through multivariate logistic regression models, with discrimination and calibration assessed using the area under the curve (AUC).
Results
The median magnesium level upon PICU admission was 2.0 mg/dl (range 1.1–4.9), and it was slightly higher in non-survivors than survivors (2.1 mg/dl; interquartile range [IQR], 1.9–2.5 vs. 2.0; IQR, 1.8–2.6, respectively), Hypermagnesemia was observed to have a negative effect on critically ill septic patients. It was also found that hypermagnesemia was associated with low C-reactive protein levels (P=0.043). With a cutoff of 5.5, the pediatric Sequential Organ Failure Assessment score strongly predicted mortality (AUC=0.717, P<0.001), with a sensitivity of 64.3% and specificity of 68.8%.
Conclusions
As an initial predictor of mortality, the serum magnesium level cannot be used alone; however, hypermagnesemia has a negative impact on critically ill septic patients. Thus, healthcare professionals should be cautious with magnesium administration.

Infection
Challenges of implementing the hour-1 sepsis bundle: a qualitative study from a secondary hospital in Indonesia: Priyo Sasmito, Satriya Pranata, Rian Adi Pamungkas, Etika Emaliyawati, Nisa Arifani; Acute Crit Care. 2024;39(4):545-553. Published online November 27, 2024; DOI: https://doi.org/10.4266/acc.2023.01473

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Abstract PDF: Background
Good sepsis management is key to successful sepsis therapy and optimal patient outcomes. Objectives: This study aimed to determine obstacles among nurses and doctors to implementing the hour-1 sepsis bundle in a secondary hospital in Indonesia.
Methods
This was a qualitative study with a phenomenological approach. Data were obtained from one-on-one in-depth interviews with 13 doctors and nurses in the intensive care unit and emergency department who were purposively sampled. Data were analyzed using content analysis.
Results
Five main themes were revealed in the analysis: incomplete implementation of the hour-1 sepsis bundle, lack of knowledge about the hour-1 sepsis bundle, cost issues, lack of supporting facilities, and lack of coordination among health workers.
Conclusions
Optimizing regional health laboratories, optimizing the use of quick Sequential Organ Failure Assessment (qSOFA) and SOFA, and creating a series of sepsis protocols within the hospital are some solutions that secondary hospitals can implement to ensure appropriate management of sepsis cases. Involvement of health policyholders and hospital management is needed to address these challenges.

Pediatrics
A deep learning model for estimating sedation levels using heart rate variability and vital signs: a retrospective cross-sectional study at a center in South Korea: You Sun Kim, Bongjin Lee, Wonjin Jang, Yonghyuk Jeon, June Dong Park; Acute Crit Care. 2024;39(4):621-629. Published online November 25, 2024; DOI: https://doi.org/10.4266/acc.2024.01200; Retraction in: https://doi.org/

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Surgery
Effects of closed- versus open-system intensive care units on mortality rates in patients with cancer requiring emergent surgical intervention for acute abdominal complications: a single-center retrospective study in Korea: Jae Hoon Lee, Jee Hee Kim, Ki Ho You, Won Ho Han; Acute Crit Care. 2024;39(4):554-564. Published online November 25, 2024; DOI: https://doi.org/10.4266/acc.2024.00808

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Abstract PDF Supplementary Material

Background
In this study, we aimed to compare the in-hospital mortality of patients with cancer who experienced acute abdominal complications that required emergent surgery in open (treatment decisions made by the primary attending physician of the patient's admission department) versus closed (treatment decisions made by intensive care unit [ICU] intensivists) ICUs.
Methods
This retrospective, single-center study enrolled patients with cancer admitted to the ICU before or after emergency surgery between November 2020 and September 2023. Univariate and logistic regression analyses were conducted to explore the associations between patient characteristics in the open and closed ICUs and in-hospital mortality.
Results
Among the 100 patients (open ICU, 49; closed ICU, 51), 23 died during hospitalization. The closed ICU group had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, vasopressor use, mechanical ventilation, and preoperative lactate levels and a shorter duration from diagnosis to ICU admission, surgery, and antibiotic administration than the open ICU group. Univariate analysis linked in-hospital mortality and APACHE II score, postoperative lactate levels, continuous renal replacement therapy (CRRT), and mechanical ventilation. Multivariate analysis revealed that in-hospital mortality rate increased with CRRT use and was lower in the closed ICU.
Conclusions
Compared to an open ICU, a closed ICU was an independent factor in reducing in-hospital mortality through prompt and appropriate treatment.

Citations

Citations to this article as recorded by

The efficacy of intensivist-led closed-system intensive care units in improving outcomes for cancer patients requiring emergent surgical intervention
Eun Young Kim
Acute and Critical Care.2024; 39(4): 640. CrossRef

Trauma
Factors associated with unplanned intensive care unit readmission among trauma patients in Republic of Korea: Yongwoong Lee, Byung Hee Kang; Acute Crit Care. 2024;39(4):583-592. Published online November 22, 2024; DOI: https://doi.org/10.4266/acc.2024.00584

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Abstract PDF: Background
In trauma patients, unplanned intensive care unit (ICU) readmission (UIR) is associated with poor clinical outcomes. In this study, we aimed to analyze associated factors for UIR in trauma patients.
Methods
This retrospective study was conducted on trauma patients admitted to the ICU at a trauma center from January 2016 to December 2022. Clinical information at admission, the first ICU hospitalization, first discharge from the ICU, and reasons for readmission were collected. Patients who were successfully discharge from the ICU were compared to UIR patients. Logistic regression was performed to determine the factors with a significant impact on ICU readmission.
Results
Here, 5,529 patients were admitted to the ICU over 7 years, and 212 patients (3.8%) experienced UIR. Among patients who experienced UIR, 9 (4.2%) died. In the UIR patients, hospital stay (20 days [interquartile range, 13–35] vs. 45 days [28–67], P<0.001), total ICU stay (5 days [3– 11] vs. 17 days [9–35], P<0.001), and complications during the first ICU hospitalization were significantly higher. The most common reason for UIR was respiratory problem (53.8%). In multivariable analysis, cervical spine operation during the first ICU hospitalization (odds ratio, 6.56; 95% CI, 3.62–11.91; P<0.001), renal replacement therapy (RRT; 3.52, 2.06–5.99, P<0.001), and massive blood transfusion protocol (MTP; 1.74, 1.08–2.81, P=0.023) were most highly related with UIR.
Conclusions
Because UIR patients had poor outcomes, trauma patients who underwent cervical spine operation, RRT, or MTP require monitoring in the general ward, especially for respiratory problems.

Infection
Striving for excellence in ventilator bundle compliance through continuous quality improvement initiative in the intensive care unit of a tertiary care hospital in India: Naveen Paliwal, Pooja Bihani, Rishabh Jaju, Sadik Mohammed, Prabhu Prakash, Vidya Tharu; Acute Crit Care. 2024;39(4):535-544. Published online November 12, 2024; DOI: https://doi.org/10.4266/acc.2024.00101

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Abstract PDF: Background
Ventilator-associated pneumonia (VAP) is a significant nosocomial infection in intensive care units (ICUs). Ventilator bundle (VB) implementation has been shown to decrease the incidence of VAP. This study presents a 1-year quality improvement (QI) project conducted in the ICU of a tertiary care hospital with the goal of increasing VB compliance to greater than 90% and evaluating its impact on VAP incidence and ICU length of stay.
Methods
A series of Plan-Do-Study-Act (PDSA) cycles, including educational boot camps, checklist implementation, and simulation-based training, was implemented. Emphasis on standardization and documentation for each VB component further improved compliance. Data were compared using a chi-square test, unpaired t-test, or Mann-Whitney U-Test, as appropriate. A P-value <0.05 was considered statistically significant.
Results
The initial observed compliance was 40.7%, with a significant difference between knowledge and implementation. The compliance increased to 90% after the second PDSA cycle. In the third PDSA cycle, uniformity and standardization of all components of VAP were ensured. After increasing the VB compliance at greater than 90%, there was a significant decline in the incidence of VAP, from 62.4/1,000 ventilatory days to 25.7/1,000 ventilatory days, with a 2.34 times risk reduction in the VAP rate (P= 0.004)
Conclusions
The study highlights the effectiveness of a structured QI approach in enhancing VB compliance and reducing VAP incidence. There is a need for continued education, protocol standardization, and continuous monitoring to ensure the sustainability of this implementation.

Epidemiology
Red blood cell transfusion for critically ill patients admitted through the emergency department in South Korea: Tae Sung Kim, Yongil Cho, Hyuk Joong Choi, Joonbum Park, Wonhee Kim, Chiwon Ahn, Joon Young Kim; Acute Crit Care. 2024;39(4):517-525. Published online November 5, 2024; DOI: https://doi.org/10.4266/acc.2024.00577

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Abstract PDF: Background
Red blood cells (RBCs) are a limited resource, and the adverse effects of transfusion must be considered. Multiple randomized controlled trials on transfusion thresholds have been conducted, leading to the establishment of a restrictive transfusion strategy. This study aimed to investigate the status of RBC transfusions in critically ill patients.
Methods
This cohort study was conducted at five university hospitals in South Korea. From December 18, 2022, to November 30, 2023, 307 nontraumatic, anemic patients admitted to intensive care units through the emergency departments were enrolled. We determined whether patients received RBC transfusion, transfusion triggers, and the clinical results.
Results
Of the 154 patients who received RBC transfusions, 71 (46.1%) had a hemoglobin level of 7 or higher. Triggers other than hemoglobin level included increased lactate levels in 75 patients (48.7%), tachycardia in 47 patients (30.5%), and hypotension in 46 patients (29.9%). The 28-day mortality rate was not significantly reduced in the group that received transfusions compared to the non-transfusion group (21.4% vs. 26.8%, P=0.288). There was no difference in the intensive care unit and hospital length of stay or the proportion of survival to discharge between the two groups. The prognosis showed the same pattern in various subgroups.
Conclusions
Despite the large number of RBC transfusions used in contradiction to the restrictive strategy, there was no notable difference in the prognosis of critically ill patients. To minimize unnecessary RBC transfusions, the promotion of transfusion guidelines and research on transfusion criteria that reflect individual patient conditions are required.

Nursing
A study to assess the psychosocial needs of patient family members in the intensive care unit in India: Lalthlanawmi Renthlei, Ronur Srikantasastry Ramesh, Mahalakshmy Thulasingam, Manjini Jeyaram Kumari; Acute Crit Care. 2024;39(3):420-429. Published online August 30, 2024; DOI: https://doi.org/10.4266/acc.2023.01116

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Abstract PDF: Background
Admission to an intensive care unit (ICU) is considered a mental crisis for patients and their families as they are unprepared for such a stressful and difficult situation. Hence, the objectives of this study are to assess the psychosocial needs of patient family members in the ICU in various dimensions such as assurance, proximity, information, support, and comfort; and to associate their psychosocial needs with their socio-demographic variables and clinical variables of the patient.
Methods
This was a cross-sectional analytical study conducted between December 2021 and January 2022 among 188 family members of patients admitted to the ICU using a convenience sampling technique in a tertiary hospital in Puducherry, India. The modified Critical Care Family Needs Inventory (CCFNI) questionnaire was administered to all consenting family members to determine their needs.
Results
The overall most important need among the five dimensions of modified CCFNI scores identified by the family members is the need for assurance (2.71±0.38). Using analysis of variance, statistical significances were found as follows. Education and comfort (F-statistic and P-value): 2.76 (0.029); relationship with the patient and assurance: 2.61 (0.036); relationship with the patient and support: 2.44 (0.048); level of consciousness and comfort: 4.63 (0.010); ICU visit restriction and assurance: 3.28 (0.022); ICU visit restriction and comfort: 8.08 (<0.001).
Conclusions
Since family members are essential members of the treatment teams, nurses should concentrate on reassuring them, assisting them in emerging from crises through appropriate communication, offering support, and attending to their needs.

Epidemiology
The impact of age on mortality in the intensive care unit: a retrospective cohort study in Malaysia: Abdul Jabbar Ismail, W Mohd Nazaruddin W Hassan, Mohd Basri Mat Nor, Wan Fadzlina Wan Muhd Shukeri; Acute Crit Care. 2024;39(3):390-399. Published online August 12, 2024; DOI: https://doi.org/10.4266/acc.2024.00640

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Abstract PDF

Background
Age is a significant consideration for intensive care unit (ICU) admission. However, the reported associations between increasing age and mortality vary across studies, and data in the local context of Malaysia are lacking. The objective of the present study was to determine the impact of increasing age on ICU mortality.
Methods
A retrospective cohort study of ICU patients was conducted between January 2020 and November 2023 at a university hospital in Malaysia. Patients were classified into two categories according to age (years) and into four groups according to National Library of Medicine Medical Subject Headings (MeSH): young adult (19–24), adult (25–44), middle age (45–64), and elderly (≥65). The Cochran-Armitage test for trend and Cox proportional hazards regression analyses were performed to evaluate the impact of increasing age on ICU mortality.
Results
A total of 1,661 patients was analyzed. The Cochran-Armitage test showed a significant positive association between ICU mortality rate and age group (Z=−4.86, P<0.01) or MeSH category (Z=−5.36, P<0.01). After adjusting for other confounders, the strongest predictor for ICU mortality in the Cox proportional hazards regression analyses was age, with the elderly age group having the highest adjusted hazard ratio of 4.777 (95% CI, 1.128–20.231; P=0.03).
Conclusions
Age had a significant impact on ICU mortality in our cohort of critically ill patients.

Citations

Citations to this article as recorded by

Early Mortality Prediction in Intensive Care Unit Patients Based on Serum Metabolomic Fingerprint
Rúben Araújo, Luís Ramalhete, Cristiana P. Von Rekowski, Tiago A. H. Fonseca, Luís Bento, Cecília R. C. Calado
International Journal of Molecular Sciences.2024; 25(24): 13609. CrossRef

Review Article

Nursing
Specialized nursing intervention on critically ill patient in the prevention of intubation-associated pneumonia: an integrative literature review: Daniela Fradinho Almeida, Maria do Rosário Pinto, Maria Candida Durao, Helga Rafael Henriques, Joana Ferreira Teixeira; Acute Crit Care. 2024;39(3):341-349. Published online August 12, 2024; DOI: https://doi.org/10.4266/acc.2024.00528

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Abstract PDF: Healthcare-associated infections are adverse events that affect people in critical condition, especially when hospitalized in an intensive care unit. The most prevalent is intubation-associated pneumonia (IAP), a nursing-care-sensitive area. This review aims to identify and analyze nursing interventions for preventing IAP. An integrative literature review was done using the Medline, CINAHL, Scopus and PubMed databases. After checking the eligibility of the studies and using Rayyan software, ten final documents were obtained for extraction and analysis. The results obtained suggest that the nursing interventions identified for the prevention of IAP are elevating the headboard to 30º; washing the teeth, mouth and mucous membranes with a toothbrush and then instilling chlorohexidine 0.12%–0.2% every 8/8 hr; monitoring the cuff pressure of the endotracheal tube (ETT) between 20–30 mm Hg; daily assessment of the need for sedation and ventilatory weaning and the use of ETT with drainage of subglottic secretions. The multimodal nursing interventions identified enable health gains to be made in preventing or reducing IAP. This area is sensitive to nursing care, positively impacting the patient, family, and organizations. Future research is suggested into the effectiveness of chlorohexidine compared to other oral hygiene products, as well as studies into the mortality rate associated with IAP, with and without ETT for subglottic aspiration.

Original Article

Nursing
Sleep, anxiety, depression, and stress in critically ill patients: a descriptive study in a Portuguese intensive care unit: Rui Domingues Silva, Abílio Cardoso Teixeira, José António Pinho, Pedro Marcos, José Carlos Santos; Acute Crit Care. 2024;39(2):312-320. Published online May 30, 2024; DOI: https://doi.org/10.4266/acc.2023.01256

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Abstract PDF

Background
Sleep disorders are common among patients admitted to intensive care units (ICUs). This study aimed to assess the perceptions of sleep quality, anxiety, depression, and stress reported by ICU patients and the relationships between these perceptions and patient variables.
Methods
This cross-sectional study used consecutive non-probabilistic sampling to select participants. All patients admitted for more than 72 hours of ICU hospitalization at a Portuguese hospital between March and June 2020 were asked to complete the “Richard Campbell Sleep Questionnaire” and “Anxiety, depression, and Stress Assessment Questionnaire.” The resulting data were analyzed using descriptive statistics, Pearson’s correlation coefficient, Student t-tests for independent samples, and analysis of variance. The significance level for rejecting the null hypothesis was set to α ≤0.05.
Results
A total of 52 patients admitted to the ICU for at least 72 hours was recruited. The mean age of the participants was 64 years (standard deviation, 14.6); 32 (61.5%) of the participants were male. Approximately 19% had psychiatric disorders. The prevalence of self-reported poor sleep was higher in women (t[50]=2,147, P=0.037) and in participants with psychiatric problems, although this difference was not statistically significant (t[50]=–0.777, P=0.441). Those who reported having sleep disorders before hospitalization had a worse perception of their sleep.
Conclusions
Sleep quality perception was worse in female ICU patients, those with psychiatric disorders, and those with sleep alterations before hospitalization. Implementing early interventions and designing nonpharmacological techniques to improve sleep quality of ICU patients is essential.

Citations

Citations to this article as recorded by

Effects of a Multimodal Intervention on Sleep Quality and Duration in Intensive Care Unit Patients
Jieun Nam, Sukhee Ahn
Journal of Korean Critical Care Nursing.2025; 18(1): 70. CrossRef
Frailty and fear of death among geriatric patients in critical care units: A mixed methods study
Eman Arafa Hassan, Shimmaa Mohamed Elsayed, Heba Hashem Monged, Basma Taher Abdelwahab
Nursing in Critical Care.2024;[Epub] CrossRef

Review Article

Basic science and research
Sex or gender differences in treatment outcomes of sepsis and septic shock: Seung Yeon Min, Ho Jin Yong, Dohhyung Kim; Acute Crit Care. 2024;39(2):207-213. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2024.00591

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Abstract PDF

Gender disparities in intensive care unit (ICU) treatment approaches and outcomes are evident. However, clinicians often pay little attention to the importance of biological sex and sociocultural gender in their treatment courses. Previous studies have reported that differences between sexes or genders can significantly affect the manifestation of diseases, diagnosis, clinicians' treatment decisions, scope of treatment, and treatment outcomes in the intensive care field. In addition, numerous reports have suggested that immunomodulatory effects of sex hormones and differences in gene expression from X chromosomes between genders might play a significant role in treatment outcomes of various diseases. However, results from clinical studies are conflicting. Recently, the need for customized treatment based on physical, physiological, and genetic differences between females and males and sociocultural characteristics of society have been increasingly emphasized. However, interest in and research into this field are remarkably lacking in Asian countries, including South Korea. Through this review, we hope to enhance our awareness of the importance of sex and gender in intensive care treatment and research by briefly summarizing several principal issues, mainly focusing on sex and sex hormone-based outcomes in patients admitted to the ICU with sepsis and septic shock.

Citations

Citations to this article as recorded by

Clinical predictors of hospital-acquired bloodstream infections: A healthcare system analysis
Harjinder Singh, Radhika Sheth, Mehakmeet Bhatia, Abdullah Muhammad, Candi Bachour, David Metcalf, Vivek Kak
Spartan Medical Research Journal.2024;[Epub] CrossRef
Impact of metabolic syndrome on cardiovascular, inflammatory and hematological parameters in female mice subjected to severe sepsis
Leonardo Berto-Pereira, Raquel Pires Nakama, Lucas Felipe dos Santos, Aparecida Donizette Malvezi, Isabella Ramos Trevizani Thihara, Lucas Sobral de Rossi, Fabricio Seidy Ribeiro Inoue, Wander Rogério Pavanelli, Priscila Cassolla, Phileno Pinge-Filho, Mar
Biochemical and Biophysical Research Communications.2024; 739: 150966. CrossRef

Original Article

CPR/Resuscitation
Effects of ketamine on the severity of depression and anxiety following postoperative mechanical ventilation: a single-blind randomized clinical trial in Iran: Seyedbabak Mojaveraghili, Fatemeh Talebi, Sima Ghorbanoghli, Shahram Moghaddam, Hamidreza Shakouri, Ruzbeh Shamsamiri, Fatemeh Mehravar; Acute Crit Care. 2024;39(2):243-250. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2023.01186

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Abstract PDF: Background
In this study, we compare the effects of ketamine and the combination of midazolam and morphine on the severity of depression and anxiety in mechanically ventilated patients after discharge from the intensive care unit (ICU).
Methods
This randomized single-blind clinical trial included 50 patients who were candidates for craniotomy and postoperative mechanical ventilation in the ICU of 5 Azar Teaching Hospital in Gorgan City, North Iran, from 2021 to 2022. Patients were allocated to two groups by quadruple block randomization. In group A, 0.5 mg/kg of ketamine was infused over 15 minutes after craniotomy and then continued at a dose of 5 µ/kg/min during mechanical ventilation. In group B, midazolam was infused at a dose of 2–3 mg/hr and morphine at a dose of 3–5 mg/hr. After patients were discharged from the ICU, if their Glasgow Coma Scale scores were ≥14, Beck’s anxiety and depression inventories were completed by a psychologist within 2 weeks, 2 months, and 6 months after discharge.
Results
The mean scores of depression at 2 months (P=0.01) and 6 months (P=0.03) after discharge were significantly lower in the ketamine group than in the midazolam and morphine group. The mean anxiety scores were significantly lower in the ketamine group 2 weeks (P=0.006) and 6 months (P=0.002) after discharge.
Conclusions
Ketamine is an effective drug for preventing and treating anxiety and depression over the long term in patients discharged from the ICU. However, further larger volume studies are required to validate these results.

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